California Is Sued for Failing To Provide Lead Tests

Child advocates and environmentalists are suing the state of
California for failing to provide routine lead-poisoning screening for
all poor children in the state.

The lawsuit, apparently the first of its kind in the country,
alleges that the state is not complying with a 1989 federal law that
requires poor children enrolled in a part of the state's Medicaid
program to be screened for high levels of lead in their blood.

The suit was filed in a federal court in San Francisco in late
December.

Since last January, under a little-noted provision in the federal
law, poor children enrolled in a state's early and periodic screening,
diagnostic, and treatment (EPSDT) program as part of its Medicaid
program have been required to be screened for lead when "appropriate
for age and risk factors."

Research suggests that children exposed to lead may have impaired
nervous-system functioning, delayed cognitive development, and lower IQ scores.

The federal government, as well as most states, have interpreted the
1989 law in a way that allows the child's doctor to determine
when blood testing for lead is necessary.

But the California plaintiffs, which include the Natural Resources
Defense Council, the NAACP Legal Defense and Educational Fund, and the
American Civil Liberties Union, want all eligible children to be
screened during their regular checkups, even if they have no known
risks or symptoms of lead poisoning.

"It should be something that the provider initiates," said Jane
Perkins, a lawyer for the National Health Law Program, a Los
Angeles-based advocacy group that is also part of the suit.

But California officials maintain that doctors should perform a lead
blood test only if the child's health history or environment suggests
that such a step is necessary.

"We are doing what the law says we are required to do," said Norman
Hartman, a spokesman for the California Department of Health Services.
He said the state has been told by the U.S. Department of Health and
Human Services, which administers Medicaid, that its program is
legal.

William Hiscock, chief of the program initiatives branch of the
federal Medicaid bureau, said that, although EPSDT guidelines require
that all Medicaid-eligible children ages 1 to 5 be screened for lead
poisoning, it is still up to the states to determine appropriate ages
and risk factors for such screening.

Initial screening, he said, could include checking children for
signs of lead poisoning.

"It's a judgment call to say what risk is," he said. "We don't say
in our law that every child should be screened every time."

Medicaid programs in California and all other states are required
under federal law to cover poor women and their children up to age 6
who come from families with incomes less than 133 percent of the
federal poverty level. States establish their own eligibility
guidelines for older children and other adults.

Any child eligible for Medicaid is also eligible for the EPSDT
program, but their parent must request their enrollment.

In California, almost two-thirds of the poor children who are
enrolled in Medicaid participate in the state's EPSDT program.

Nationally, HHS estimates that more than 200,000 children between
the ages of 6 months and 5 years, or about 1.5 percent of all young
children, have lead levels at or above 25 micrograms per liter of
blood, the level at which action is recommended.

In response to evidence suggesting that children are affected by
even lower levels of lead, the federal government later this year is
expected to lower its recommended action level to 15 micrograms per
liter of blood.

More than 3 million preschool-age children, including two-thirds of
black inner-city children, have blood-lead levels that exceed this
expected standard, the government estimates.

Last September, Massachussetts became the first state to require all
entering kindergartners to show that they have been tested for lead
poisoning. But neither the U.S. Centers for Disease Control nor the
American Academy of Pediatrics recommends universal lead screening.
(See Education Week, Sept. 19, 1990.)

Vol. 10, Issue 20, Page 8

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